POS1182 EPIDEMIOLOGICAL, CLINICAL AND THERAPEUTIC ASPECTS OF TABETIC ARTHROPATHY IN A POPULATION OF SOUTHERN MOROCCO
Authors: P. C. Mouele Mboussi, F. E. Bennani, S. Belouaham, H. Bara, A. Mougui, I. El Bouchti
Journal: Annals of the Rheumatic Diseases (2022)

Background Tabetic arthropathies (TA) are a destructive neurogenic disease complicating 10% of syphilis at the tertiary stage. Although they have become exceptional due to early and appropriate treatment of syphilis, they are still relevant in undeveloped countries and remain difficult to manage due to the severity of the handicap and the absence of a specific treatment. Objectives We described épidemiological, clinical, biological, radiographic, and therapeutic characteristics of TA. Methods Retrospective study, from 2004 to 2021 includind patients with tabetic arthropathy, whose diagnosis was retained on clinical criteria (discordance between the importance of joint deformities and indolence), radiological (lesions destructive and constructive), biological (positive syphilitic serology in joint fluid, blood and/or cerebrospinal fluid). Results A total of 21 cases were collected, 15 men and 6 women, the mean age was 52.14 years. The history of syphilitic chancre was found in 9 patients, sexual risk behavior was noted in 8 patients, no other STI was found. Joint swelling with painless deformation was the main mode revealing the disease (76.1%), followed by pathological fracture in 3 cases and then mechanical arthralgia with neuropathic pain in 2 patients. The delay diagnosis was 6.8 years. TA concerned lower limb in 81,5%. The knee was the most affected site in 15 cases (71.4%),followed by the hip,ankles, MTP, in respectively 4(19%), 3(14%), 2(9,5%) cases. The upper limb was involved in 4 cases, with MCP involvement in one patient. TA was bilateral in 29% and multifocal in 19%. Joint instability was found in 16 patients. Involvement of the thoracolumbar spine was noted in one case. Tabetic neurological involvement was found in 16 patients (76.1%) with an Argyll Robertson sign noted in 6 cases (28.6%), a radiculocordonal posterior syndrome in 10 cases (47.6%). TPHA and VDRL were positive in blood in 21 patients, in cerebrospinal fluid in 11 patients and in synovial fluid in 9 cases. Radiological exams showed destructive and constructive lesions with the presence of intraosseous and periarticular fragments, damage to small joints was noted in two patients, bilateral talocrural involvement in one patient, a fracture with dislocation and calcification of the soft tissues was noted in two cases. Axial tabetic involvement made of vertebral compression D12, L1 L2 L3 was found in one case (4.8%). Nineteen patients (90.4%) were treated with Penicillin G and two patients with C3G. Orthopedic immobilization with weight-bearing was prescribed to all patients, the surgical indication was posed in 11 patients, 4 of whom benefited from surgery: total hip prosthesis in 3 cases, knee arthrodesis in one case. The serological evolution at the end of treatment showed a decrease in the VRDL titer in the blood, CSF, synovial fluid in 10 patients and negativity in 4 patients. Conclusion Tabetic arthropathy, one of the exceptional complications of neurosyphilis, is still relevant. Its diagnosis must reffered to any destructive and painless joint damage. Given the difficulty of treating this articular form, prevention based on the management of syphilis at an early stage before the occurrence of joint and neurological complications is essential. References: [1]Hsaini Y, Mounach J, Satté A, Zerhouni A, Qacif H, Mosseddaq R. Arthrotabes: à propos de cinq cas. La Revue de Médecine Interne. 2007 Jun;28:101 [2]Chan RLS, Chan CH, Chan HF, Pan NY. The many facets of neuropathic arthropathy. BJR Open. 2019;1(1):20180039. [3]Allali F, Rahmouni R, Hajjaj-Hassouni N. Tabetic arthropathy. A report of 43 cases. Clin Rheumatol. 2006 Sep 25;25(6):858-60. [4]Zouhair K, Akhdari N, El Ouazzani T, Lazrak S, Lakhdar H. Arthropathie tabétique: « une maladie oubliée ». Annales de Dermatologie et de Vénéréologie. 2004 Aug;131(8-9):787-9. [5]Bai Y, Niu F, Liu L, Sha H, Wang Y, Zhao S. Tertiary syphilis in the lumbar spine: a case report. BMC Infect Dis. 2017 07 24;17(1):513. Disclosure of Interests None declared